Biomedical subjects

P Jokl

Publications and source records attributed to P Jokl.

18 recordsLinked to original sources

PubMed1992

Normal and abnormal glenoid labrum: assessment with multiplanar gradient-echo MR imaging.

A retrospective study of magnetic resonance (MR) imaging of the glenoid labrum performed with multiplanar gradient-echo (MPGR) sequences was done to ascertain the different appearances of the normal labrum and the findings in patients with tears. MPGR images were obtained with a 1.5-T magnet in 37 shoulders of 16 healthy subjects and 19 patients with subsequent surgical evaluation. Increased intralabral signal intensity was seen in 12 of 26 normal shoulders (46%), and atypical morphology was seen in six shoulders (23%). Atypical morphology was present in eight of nine patients with labral tears. Deformity (n = 2 [22%]) and clefts (n = 2 [22%]) were seen in patients with tears. Deformity (n = 3 [12%]) and clefts (n = 1 [4%]) were occasionally seen in healthy subjects. Absence of the labrum and separation of the labrum from the glenoid cavity was present only in patients with tears; therefore, the labrum should be presumed torn in the presence of these findings. Increased intralabral signal intensity on MPGR images did not help predict labral integrity; morphologic findings were more predictive of labral tear.

Adolescent↗

PubMed1992

Can MR imaging effectively replace diagnostic arthroscopy?

A study was performed to determine whether magnetic resonance (MR) imaging is cost-effective and reduces the need for diagnostic arthroscopy of the knee. During a 9-month period, 103 consecutive patients with knee injury that justified diagnostic arthroscopy underwent MR imaging. The MR images were interpreted by means of consensus of three radiologists and reviewed with the referring sports medicine orthopedists. After the examination, 44 patients (42.7%) underwent immediate arthroscopy. The 59 other patients (57.3%) did not undergo arthroscopy; follow-up was performed in 55 of these 59 patients (93%) at a mean of 22 months. The outcome was successful in 49 of 55 patients (89%); 40 patients had normal function and no limitation in activity, six patients with chronic injury of the anterior cruciate ligament underwent reconstruction, and three patients underwent arthroscopy with negative findings. Without the use of MR imaging, all patients in this study would have undergone diagnostic arthroscopy. Because of the diagnoses based on MR images, 53 patients (51.4%) avoided a potentially unnecessary diagnostic arthroscopy, and, as a result, the net savings was $103,700 in the 103 patients.

Adolescent↗

PubMed1992

Chondromalacia patellae: diagnosis with MR imaging.

Most previous studies of MR imaging for detection of chondromalacia have used T1-weighted images. We correlated findings on axial MR images of the knee with arthroscopic findings to determine MR findings of chondromalacia patellae on T2-weighted and proton density-weighted images. The study population included 52 patients who had MR examination of the knee with a 1.5-T unit and subsequent arthroscopy, which documented chondromalacia patellae in 29 patients and normal cartilage in 23. The patellar cartilage was assessed retrospectively for MR signal and contour characteristics. MR diagnosis based on the criteria of focal signal or focal contour abnormality on either the T2-weighted or proton density-weighted images yielded the highest correlation with the arthroscopic diagnosis of chondromalacia. When these criteria were used, patients with chondromalacia were detected with 86% sensitivity, 74% specificity, and 81% accuracy. MR diagnosis based on T2-weighted images alone was more sensitive and accurate than was diagnosis based on proton density-weighted images alone. In conclusion, most patients with chondromalacia patellae have focal signal or focal contour defects in the patellar cartilage on T2-weighted MR images. These findings are absent in most patients with arthroscopically normal cartilage.

Adolescent↗

PubMed1992

Achilles tendon overuse injuries.

Overuse injuries of the Achilles tendon are common in patients engaging in recreational athletics. Achilles tendon overuse injuries exist as a spectrum of diseases ranging from inflammation of the paratendinous tissue (paratenonitis), to structural degeneration of the tendon (tendinosis), and finally tendon rupture. Factors known to predispose patients to Achilles tendinitis include inadequate stretching, training errors, mechanical malalignment of the lower extremities, rigid training surfaces, and occasionally systemic disease. Treatment of the patient with paratenonitis and tendinosis is initially conservative, emphasizing passive stretching, concentric and eccentric strengthening, correction of training errors, and restoration of normal limb alignment. Patients resistant to this protocol often exhibit a more advanced degree of tendon change. A high percentage of these patients can benefit from surgical debridement of the involved tendon, and they can anticipate successful return to recreational athletics. Steroid injections should not be routinely used in patients with Achilles tendinitis. Rupture of the Achilles tendon following intratendinous injection has been reported.

Achilles Tendon↗

PubMed1991

Magnetic resonance imaging of the surgically repaired meniscus: six-month follow-up.

The appearance and rate of healing of sutured meniscal repairs in 17 patients were evaluated using magnetic resonance scans. While prior studies in animals and humans (1-4) suggest that complete healing can occur as early as 6 wk postoperatively, we found that at 7 wk 15/15 patients demonstrated meniscal defects at the site of repair. At 6 mo, 11/11 patients showed persistent signal abnormalities. Two patients scanned at 11-12 mo also had defects at the site of repair. Therefore, complete meniscal healing appears not to occur as early as previously believed. This may affect decisions regarding the type of suture material used, the surgical treatment of associated injuries and the postoperative rehabilitation regimen. As defects may be present for relatively long periods of time following meniscal repair, caution must be exercised when attempting to diagnose new or recurrent tears in these patients.

Adolescent↗

PubMed1991

Follow-up of grade 2 meniscal abnormalities in the stable knee.

A prospective study of grade 2 meniscal abnormalities in patients with intact anterior cruciate ligaments was done to ascertain whether such lesions progress to complete tears. A follow-up magnetic resonance (MR) image was obtained in 22 patients in whom the initial MR image showed a grade 2 lesion in one or both menisci that had been proved at arthroscopy not to be torn. On the initial images, 27 menisci contained a grade 2 lesion. At follow-up, six of the 27 lesions appeared to have decreased in size (two had completely disappeared). Eighteen lesions appeared unchanged; only three had increased in size. The mean interval between the acquisition of initial and follow-up images was 27.3 months (range, 11-41 months). The two patients whose lesion disappeared were among the youngest patients evaluated. The three patients whose abnormality increased were slightly older and more active than average. The results suggest that in most patients grade 2 lesions are stable at up to 3 years follow-up.

Adolescent↗

PubMed1990

The clinical significance of stage 2 meniscal abnormalities on magnetic resonance knee images.

The Stage 2 meniscal abnormality was subdivided into Stage 2A--linear abnormal signal not contacting an articular surface, Stage 2B--abnormal signal in contact with the articular surface on a single image, Stage 2C--extensive wedge-shaped signal abnormality not in contact with an articular surface. Arthroscopy showed tears in 2A 3%, 2B 0%, 2C 50%. Complete tears should only be diagnosed if contact is seen on more than one image. Many Stage 2C menisci may have tears.

Adult↗

PubMed1990

Osteochondritis dissecans of the knee: a historical review of etiology and treatment.

Osteochondritis dissecans (OCD) is a common entity in both the juvenile and adult populations, with an incidence of 3 to 6/10,000 in adults. Much of the early literature grouped juvenile and adult osteochondritis dissecans, osteochondral fracture, and accessory ossification into the same category. Conclusions were then drawn on the combined group. Nonetheless, this is a diverse group. This review discusses only OCD. There have been multiple etiological theories of OCD, ranging from trauma to ischemia to accessory centers of ossification and to genetics. It is evident that the true etiology is probably multifactorial. Bone scan, computed tomographic scan, and magnetic resonance imaging advances have enhanced the physician's ability to make the diagnosis of osteochondritis dissecans as well as to stage operative intervention. There is a vast difference between juvenile and adult OCD, as seen in the natural history, prognosis, and treatment options. In general, the juvenile patients have better results overall. The indications for operative intervention for these juvenile patients are a nonhealing attached fragment, fully or partially detached lesions of the articular surface, and loose bodies. Nonoperative treatment in the adult patient has been shown to accelerate degenerative arthritis, which involves all 3 compartments of the knee. Therefore, symptomatic lesions and loose bodies comprise the surgical indications for adult OCD. An understanding of this disease process will help the physician optimize the patient's results.

England↗

PubMed1990

Meniscal abnormalities in the asymptomatic population at MR imaging.

Two hundred eighty meniscal horns in 64 asymptomatic volunteers in the 2nd to 8th decades of life were analyzed for meniscal abnormalities. Grade 1, 2, and 3 changes were present in essentially all decades. There was at least a 25% prevalence of meniscal signal abnormalities as early as the 2nd decade. The prevalence of meniscal abnormalities increased sharply with age. The prevalence of all signal abnormalities correlated with age, grade 2 changes having the highest correlation coefficient (+.88). The correlation coefficient for grades 1 and 3 changes were +.60 and +.71, respectively. The posterior horn of the medial meniscus had a significantly higher (P less than .02) prevalence of abnormalities than did the other meniscal locations. There was no significant correlation between subject weight or sex and meniscal signal. The authors conclude that there is a baseline prevalence of meniscal signal in the asymptomatic population.

Adolescent↗

PubMed1990

Prevention of disuse muscle atrophy in chronic arthritides.

This article briefly reviews the causes and physiologic considerations of skeletal muscle disuse atrophy. This is a common problem associated with chronic arthritides. Methods of preventing or modifying this disability are presented.

Arthritis↗

PubMed1978